From the Spectrum Health/Michigan State University/Helen DeVos Children's Hospital Pediatric Residency Program.
Michigan State College of Human Medicine.
Pediatr Infect Dis J. 2019 Jan;38(1):32-36. doi: 10.1097/INF.0000000000002053.
Clostridium difficile infection (CDI) is one of the most common nosocomial infections in the United States, with an increasing incidence in children. Approximately 20% of pediatric patients develop recurrent infections. It's imperative to further analyze the incidence of recurrent CDI in the pediatric population and determine the most effective treatments. The primary goal of this study is to characterize children with recurrent CDI at our institution, including both hospital-acquired CDI (HA-CDI) and community-acquired CDI (CA-CDI) cases, summarize the various treatments utilized, including fecal microbiota transplant (FMT) and compare their success rates.
A retrospective cohort study of pediatric patients 1-21 years of age treated for CDI at a single institution from January 2010 to December 2014 was performed.
There were 175 subjects with 215 separate episodes of CDI. Oral metronidazole was the most common initial treatment (145/207, 70%) followed by oral vancomycin (30/207, 15%), with recurrence rates of 30% (42/145) and 37% (11/30), respectively. Twenty-nine percent (63/215) of all initial CDI cases had at least 1 documented recurrence. Using multivariate analysis, subjects with HA-CDI were 2.6 times less likely to recur than those with CA-CDI (odds ratio: 0.39; 95% confidence interval: 0.18-0.85; P = 0.018). The overall success rate for FMT at our institution was 10/12 (83%).
Our data show that cases of HA-CDI were less likely to recur compared with CA-CDI. Although currently reserved for multiply-recurrent cases, FMT was highly successful in our small cohort. More studies on FMT should be conducted to further evaluate its usefulness in the treatment of recurrent CDI in children.
艰难梭菌感染（CDI）是美国最常见的医院获得性感染之一，其在儿童中的发病率呈上升趋势。约 20%的儿科患者会出现反复感染。进一步分析儿科人群中复发性 CDI 的发生率并确定最有效的治疗方法至关重要。本研究的主要目的是描述我院复发性 CDI 患儿的特征，包括医院获得性 CDI（HA-CDI）和社区获得性 CDI（CA-CDI）病例，总结各种治疗方法，包括粪便微生物群移植（FMT），并比较其成功率。
对 2010 年 1 月至 2014 年 12 月在一家机构接受 CDI 治疗的 1-21 岁儿科患者进行回顾性队列研究。
共有 175 名患者 215 例 CDI 发作。口服甲硝唑是最常见的初始治疗方法（145/207，70%），其次是口服万古霉素（30/207，15%），复发率分别为 30%（42/145）和 37%（11/30）。所有初始 CDI 病例中有 29%（63/215）至少有 1 次记录的复发。多变量分析显示，HA-CDI 患者的复发率比 CA-CDI 患者低 2.6 倍（比值比：0.39；95%置信区间：0.18-0.85；P = 0.018）。我们机构的 FMT 总体成功率为 10/12（83%）。
我们的数据表明，与 CA-CDI 相比，HA-CDI 病例的复发率较低。尽管目前保留用于多次复发的病例，但 FMT 在我们的小队列中非常成功。应开展更多关于 FMT 的研究，以进一步评估其在儿童复发性 CDI 治疗中的作用。
